Provider Demographics
NPI:1467085084
Name:WILLIAMS, HEATHER D (CNA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 W 26TH ST APT A104
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3135
Mailing Address - Country:US
Mailing Address - Phone:913-626-8491
Mailing Address - Fax:
Practice Address - Street 1:2305 W 26TH ST APT A104
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3135
Practice Address - Country:US
Practice Address - Phone:913-626-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS120637376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide